The Manly Way to Beautify

Doreen Wu (00:00):
Welcome to Park Avenue Plastic Surgery Class, a podcast where we explore controversies and breaking issues in plastic surgery. I'm your co-host Dorene Wu, a clinical assistant at Bass Plastic Surgery in New York City. I'm excited to be here with Dr. Lawrence Bass, Park Avenue plastic surgeon, educator, and technology innovator. The title of today's episode is "The Manly Way to Beautify." Of course, we all know plastic surgery is for men and women. Dr. Bass, how involved in plastic surgery are men these days? What is their approach?

Dr. Lawrence Bass (00:35):
Men are very involved in plastic surgery, but typically take a different approach than most women. This means the surgeon needs to take a different approach as well.

Doreen Wu (00:45):
What if we take a look at the numbers? How many men compared to women are having things done?

Dr. Lawrence Bass (00:50):
The American Society of Plastic Surgeons compiles statistics every year on all manner of plastic surgery, the number of cases, gender distribution, age distribution, and so forth. So the statistics show that men represent only about 8% of plastic surgeries and treatments with 92% being women, but men's utilization of plastic surgery is growing.

Doreen Wu (01:25):
What about goals and preferences when it comes to procedures? What are men doing surgically?

Dr. Lawrence Bass (01:30):
Well, men are typically doing procedures that are focused on promoting male shapes and on rejuvenating their face and their body. So it's more or less the same thing that women are doing except for men. It does focus a little bit differently on certain procedures, though, that are specific for men. Things like excess contour in the chest area, which is medically called gynecomastia. That's a very common procedure for men because they would like to have a male chest contour and not a female appearing chest contour. And this, of course, is different from people that are trying to change their gender representation, which is really a separate subject.

Doreen Wu (02:22):
Dr. Bass, you mentioned that the approach is different. Can you elaborate on that further?

Dr. Lawrence Bass (02:28):
So, men tend to think about their appearance differently. They work on their appearance differently On average they tend to be project oriented. They see a problem, they want to research how to address it, what the options are. They want to understand what the mechanics are going to be, and then they want to pull the trigger and do it and be done with it. There tends to be less thought about maintenance of appearance. "Just fix it and let me go out and do my thing."

Doreen Wu (03:05):
Are there differences by age? What are the main younger guy procedures, so to speak?

Dr. Lawrence Bass (03:11):
So this really gets to that distinction between image modification versus rejuvenation. So that's one big group of plastic surgery procedures that are designed to change what we look like. And there's a whole other group of plastic surgery procedures designed to make us look younger, set our appearance back to where it was a few years ago. So younger men are changing appearance. Older men are trying to restore appearance more often than not.

Doreen Wu (03:54):
How are these done differently from the way women approach them?

Dr. Lawrence Bass (03:58):
So if we look at the young person plastic surgery procedures, these are things like rhinoplasty, which is also very common in young women, cheek implants and other facial implants, and liposuction. So those are typical young man surgery procedures. And these are going to be done a little bit differently in a man. A a typical male body shape is different and men will work on things like ab etching trying to show a six pack or trying to build a squared off chest shape or broad shoulders. We're even building biceps and things like that. So those are more common in, much more common in male patients than female patients where females are trying to maintain a female curvy shape, but reduce bulges and fat, which men are trying to do also. But the approach to shaping is going to be different and gender specific.

(05:07):
If we think about things like rhinoplasty or cheek implants, the same kind of issues apply what might be an attractive strong nose on a man might be a little bit too heavy handed for a good harmony with the rest of a female facial shape, which is a little curvier and less angular typically than male facial shapes. So rhinoplasty goals are in broad strokes, similar. Nobody likes an over long nose or an over projecting nose or a really broad nose or a big bump on the nose. But in terms of what the balance and harmony is going to be like, very different between men and women. Same idea with cheeks. I wrote a chapter in the textbook on male plastic surgery on cheek shape, both with surgical procedures and with fillers. And male cheek shape is different than female shape. There's less roundness, there's less fullness in volume. The apex or or peak accent point of the cheek is located differently on men and women. And so all of that has to be accounted for in how you do any procedure. So you create and amplify a male shape that's attractive rather than a female shape because the intent is to preserve gender identification in these kind of procedures, different from gender reassignment sorts of procedures. And so we're trying to focus appropriately for men rather than just do it the same way on everyone.

Doreen Wu (06:55):
Okay. So now that we've talked about image modification procedures, let's talk about rejuvenation. What are the main rejuvenation procedures?

Dr. Lawrence Bass (07:04):
In my experience, the main procedures are chasing appearance around the eyelids, particularly blepharoplasty because that addresses the bags under the eyes and it addresses, the hanging or heavy skin in the upper lid. And both of those things really make a man look tired and worn out, and that's not a good look. You know, even if you're a corporate executive and you're supposed to be mature and seasoned and experienced looking, worn out is not a good look. You still want to look energetic the way you feel, but that's no longer the way your image is projecting itself. So you start to think about cleaning up that area. So you look rested, alert, fresh, but always extremely natural. It's critically important for everyone to have a natural look, but that's doubly true in men because it's not as socially acceptable for men to modify their appearance and show that they're modifying it.

(08:13):
We're supposed to look more wash and wear. So perfectly natural is always essential for men. The other area that men tend to start chasing as they age is their neck area and very early in the game. Some of the nonsurgical techniques may be helpful here with energy treatments like Ultherapy. But as aging progresses, this becomes increasingly surgical, which is always the item that men are trying to avoid. They tend to try to put off the neck lift. So there are some earlier options, occasionally liposuction in men in their forties if the neck has gotten heavy, which again gives it a non energetic and non decisive look. Once there's a component of muscle banding, then minimally invasive procedures like my elevate are a good option. But eventually when there's a lot of hanging skin and a very full neck, this becomes a surgical neck lift. And men, again, are reluctant to do this, but properly done, they preserve a very natural look, and it goes a tremendous way to rejuvenating their appearance and giving them back that strong jawline, which is such a virile and attractive feature on men.

Doreen Wu (09:47):
I'm going to pose the same question again. How are these done differently from the way women approach them?

Dr. Lawrence Bass (09:53):
If we look at the typical shape or appearance of women's eyelids when they're young, just as an example, women will tend to have a very clean upper eyelid. Men even in their twenties, will typically show some hooding of skin or a more distinct fold of skin in the lid than most women will in their twenties. If you do an eyelid procedure the way it's typically done in women to really clean the upper lid, that will feminize the lid in men. And so we take out a crescent of extra skin in the upper eyelid, but we're trying to leave that minimal amount of hooding that's typically present in youth and not eliminate that which would give a feminine look to the lid. This also applies in the eyebrow. Most women's eyebrows have some arching to them and are higher than male eyebrows. And if you take a man's eyebrow again in their twenties when they're still youthful, it's typically much straighter than the average woman's eyebrow. If you arch a man's eyebrow, it's going to feminize it. If you over elevate it, it feminizes it and makes it look unnatural.

(11:24):
So we're trying to avoid all of those tell tales and unnatural things. We just want to put male facial appearance where it was in as youthful estate as we can, but it's a mistake to do it in a monolithic fashion, the same on everybody. And it's often useful to look at pictures of people in their twenties to see what their facial shape was like and bring it back. There are modifications to incisions and positioning in the neck lift to take account of the fact that men grow a beard where women don't. We need to preserve natural appearance around the ear, men tend to have a shorter hairstyle and it's essential that incisions be concealed. And of course, some men have lost a lot of hair and may be balding or have chosen to shave their head. And so this presents some special challenges for trying to conceal incisions when you're doing a neck lift or other facial surgery so that they're not obvious where women who on average have a longer hairstyle, even if they're wearing their hair relatively short, will have an easier time concealing incisions. So there's some modification on that basis to really keep the incisions stealth. So nobody knows that something's been done.

Doreen Wu (13:06):
Now, Dr. Bass, are men jumping on board with non-surgical options?

Dr. Lawrence Bass (13:10):
They are, although as I mentioned, there's less focus on recurrent treatments and in particular on skin care, most men don't think a lot about skin care if they're smart and concerned they're using sunscreen. But men don't tend on average to enjoy the experience of having moisturizer on their skin. A lot of medicated products in skin care are in moisturizer type bases, and so they give a more lubricated feel to the skin. And even sometimes appearance on the skin, which is less socially acceptable for men. There are other skin care products that are formulated in lighter bases so that there's less feel of having something on the skin, but it still lets men chase the skin care with whatever medicated product may be useful for them. And so this is slowly changing the amount of time and effort that men are investing in maintenance projects, nonsurgical treatments, daily skin care. And this is especially true in younger patients.

Doreen Wu (14:36):
What are procedural preferences here? What are men doing that are non-surgical?

Dr. Lawrence Bass (14:41):
That's a great question, and again, we'll turn to the American Society of Plastic Surgeons statistics, along with my experience in my clinical practice in New York City. men do a lot of the same things that women do just as they do in the surgical procedures. Botox is very popular. Fillers are becoming more popular, but things that improve the appearance of the skin, taking off age spots like IPL treatments, laser skin resurfacing, that will also chase wrinkles are very popular procedures for men. And then things like laser hair removal for very hairy chests and bellies and backs, things like that can be treated with laser hair removal, much more expeditiously than you can with waxing or certainly just impractical with things like electrolysis.

Doreen Wu (15:54):
Dr. Bass, can you give our listeners both male and female some parting takeaways from this episode?

Dr. Lawrence Bass (16:01):
Sure. We're talking about what's average or typical for the male population of plastic surgery patients. So in some ways these are stereotypes. They don't represent a rule, just a presentation of what in fact the male population is doing, but there are exceptions all over the place. And you can feel free to pursue whatever you choose to. Just remember, there are differences in how men and women look in youth, and there are also significant differences in how men and women age, which is due to differences in hormones. Male and female hormones have different effects on preserving appearance and with menopause, there's a big aging change in women that men don't experience. There are morphological factors. Men's bone structure tends to be thicker, heavier, more angular, which slows the appearance of skin laxity. Men's skin is thicker and thicker skin, whether male or female, tends to age more slowly, but on average, male skin is thicker than the average for women.

(17:27):
So these make some significant difference. Looking at what men are doing and how they promote their image in their work and personal relationships gives you an idea of what resonates with the male psyche and what people in public seem to be responding to, which encourages men to continue to do those kinds of treatments. So that's the basis for the analysis I've provided in this episode. To give an understanding of some of the differences between men and women. The most important thing is every patient, every surgeon needs to make a careful assessment. Be gender specific, if the intention is to preserve gender identity, and then also make an individual plan that's specific for your individual needs, your individual appearance issues, rather than doing something that's cookie cutter because everyone else is doing it.

Doreen Wu (18:40):
Thank you Dr. Bass for sharing your insight and expertise with us about an important topic in plastic surgery that is growing in popularity and prevalence. Thank you for listening to the Park Avenue Plastic Surgery Class podcast. Follow us on Apple Podcasts, write a review and share the show with your friends. Be sure to join us next time to avoid missing all the great content that's coming your way. If you wanna contact us with commons or questions, we'd love to hear from you, send us an email at podcast@drbass.net or DM us on Instagram @drbassnyc.